Provider Demographics
NPI:1518413863
Name:COMPLETE FAMILY EYECARE OF CARBONDALE, PC
Entity Type:Organization
Organization Name:COMPLETE FAMILY EYECARE OF CARBONDALE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHASE
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:RUDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-942-5465
Mailing Address - Street 1:1241 EAST WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901
Mailing Address - Country:US
Mailing Address - Phone:618-942-5465
Mailing Address - Fax:618-942-7042
Practice Address - Street 1:1241 EAST WALNUT STREET
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901
Practice Address - Country:US
Practice Address - Phone:618-942-5465
Practice Address - Fax:618-942-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty